Diarrhea

Overview

What is diarrhea?

Going to the bathroom, having a bowel movement, pooping – no matter what you call it, stool is a regular part of your life. However, sometimes this process of getting waste out of your body changes. When you have loose or watery stool, it’s called diarrhea. This is a very common condition and usually resolves without intervention.

Diarrhea can happen for a wide variety of reasons and it usually goes away on its own in one to three days. When you have diarrhea, you may need to quickly run to the bathroom with urgency and this may happen more frequently than normal. You may also feel bloated, have lower abdominal cramping and sometimes experience nausea.

Although most cases of diarrhea are self-limited (happening for a fixed amount of time and steady level of severity), sometimes diarrhea can lead to serious complications. Diarrhea can cause dehydration (when your body loses large amounts of water), electrolyte imbalance (loss of sodium, potassium and magnesium that play a key role in vital bodily functions) and kidney failure (not enough blood/fluid is supplied to the kidneys). When you have diarrhea, you lose water and electrolytes along with stool. You need to drink plenty of fluids to replace what’s lost. Dehydration can become serious if it fails to resolve (get better), worsens and is not addressed adequately.

What’s the difference between normal diarrhea and severe diarrhea?

There are actually several different ways to classify diarrhea. These types of diarrhea include:

  • Acute diarrhea: The most common, acute diarrhea is loose watery diarrhea that lasts one to two days. This type doesn’t need treatment and it usually goes away after a few days.
  • Persistent diarrhea: This type of diarrhea generally persists for several weeks – two to four weeks
  • Chronic diarrhea: Diarrhea that lasts for more than four weeks or comes and goes regularly over a long period of time is called chronic diarrhea.

Who can get diarrhea?

Anyone can get diarrhea. It’s not uncommon for many people to have diarrhea several times a year. It’s very common and usually not a major concern for most people.

However, diarrhea can be serious in certain groups of people, including:

  • Young children.
  • Older adults (the elderly).
  • Those with medical conditions.

For each of these people, diarrhea can cause other health problems.

Can diarrhea harm your health?

In general, diarrhea is self-limited and goes away (resolves) without intervention. If your diarrhea fails to improve and resolve completely, you can be at risk of complications (dehydration, electrolyte imbalance, kidney failure and organ damage).

Call your healthcare provider if you have diarrhea that fails to get better or go away, or if you experience symptoms of dehydration. These symptoms can include:

  • Dark urine and small amounts of urine or loss of urine production.
  • Rapid heart rate.
  • Headaches.
  • Flushed, dry skin.
  • Irritability and confusion.
  • Light-headedness and dizziness.
  • Severe nausea and vomiting, the inability to tolerate or keep anything down by mouth.

Symptoms and Causes

What causes diarrhea?

The cause of most self-limited diarrhea is generally not identified. The most common cause of diarrhea is a virus that infects your bowel (“viral gastroenteritis”). The infection usually lasts a couple of days and is sometimes called “intestinal flu.”

Other possible causes of diarrhea can include:

  • Infection by bacteria.
  • Infections by other organisms and pre-formed toxins
  • Eating foods that upset the digestive system.
  • Allergies and intolerances to certain foods (Celiac disease or lactose intolerance).
  • Medications.
  • Radiation therapy.
  • Malabsorption of food (poor absorption).

Can antibiotics cause diarrhea?

Most antibiotics (clindamycin, erythromycins and broad spectrum antibiotics) can cause diarrhea. Antibiotics can change the balance of bacteria normally found in the intestines, allowing certain types of bacteria like C. difficile to thrive. When this happens, your colon can become overrun by bad (pathologic) bacteria that causes colitis (inflammation of your colon lining).

Antibiotic-associated diarrhea can begin any time while you’re taking the antibiotic or shortly thereafter. If you experience this side effect, call your healthcare provider to talk about the diarrhea and discuss the best option to relieve this side effect.

What are the symptoms of diarrhea?

The symptoms you can experience when you have diarrhea can vary depending on if it’s mild or severe and what the cause of the diarrhea happens to be. There’s a link between severe cases of diarrhea and a medical condition that needs to be treated.

When you have diarrhea, you may experience all of these symptoms or only a few. The main symptom of diarrhea is loose or watery stool.

Other symptoms of mild diarrhea can include:

  • Bloating or cramps in the abdomen.
  • A strong and urgent need to have a bowel movement.
  • Nausea (upset stomach).

If you have severe diarrhea, you may experience symptoms like:

  • Fever.
  • Weight loss.
  • Dehydration.
  • Severe pain.
  • Vomiting.
  • Blood.

Severe diarrhea can lead to significant complications. If you have these symptoms, call your healthcare provider and seek medical attention.

Diagnosis and Tests

Is there a color of diarrhea that I should be worried about?

The color of your poop (stool) can vary. Stool color can be influenced by the color of the food you eat. Usually, this isn’t something you need to worry about. But if you ever see red (blood) in your stool or have a bowel movement that is black, that could be something more serious. Keep a record of any bowel movements that:

  • Are black and tarry.
  • Have blood or pus in them.
  • Are consistently greasy or oily despite non-fatty meals.
  • Are very foul-smelling.

How do you diagnose diarrhea?

For the majority of mild diarrhea cases, you won’t need medical attention. These cases are self-limited (only lasts for a fixed amount of time) and get better without medical intervention. The key to mild diarrhea is supportive therapy – staying hydrated and eating a bland diet.

More serious cases of diarrhea may require medical attention. In these situations, there are a few diagnostic tests that your provider may order. These tests can include:

  • Discussing a detailed family history, as well as physical and medical conditions, your travel history, and any sick contacts you may have.
  • Doing a stool test on a collected stool sample to check for blood, bacterial infections, parasite and inflammatory markers.
  • Doing a breath test to check for lactose or fructose intolerance, and bacterial overgrowth.
  • Doing blood work to rule out medical causes of diarrhea such as a thyroid disorder, celiac sprue and pancreatic disorders.
  • Doing endoscopic evaluations of your upper and lower digestive tract to rule out organic abnormalities (ulcers, infections, neoplastic process).

Management and Treatment

How is diarrhea treated?

In most cases, you can treat mild and uncomplicated diarrhea at home. By using an over-the-counter product like bismuth subsalicylate (Pepto-Bismol® or Kaopectate®) you’ll usually feel better very quickly.

However, over-the-counter medications aren’t always the solution. If your diarrhea is caused by an infection or parasite, you’ll need to see a healthcare provider for treatment. A general rule is not to use over-the-counter medications for diarrhea if you also have a fever or blood in your stool. In those cases, call your healthcare provider.

When diarrhea lasts for a long period of time (several weeks), your healthcare provider will base your treatment on the cause. This could involve a few different treatment options, including:

  • Antibiotics: Your healthcare provider might prescribe an antibiotic or other medication to treat an infection or parasite that’s causing the diarrhea.
  • Medication for a specific condition: Diarrhea can be a sign of several other medical conditions, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) such as Crohn’s disease and ulcerative colitis, microscopic colitis, or bacterial overgrowth. Once the cause of the diarrhea is identified, diarrhea can usually be controlled.
  • Probiotics: Groupings of good bacteria, probiotics are sometimes used to re-establish a healthy biome to combat diarrhea. Introducing probiotics can be helpful in some cases and some healthcare providers feel that it’s worth a try. Always talk to your provider before starting a probiotic or any kind of supplement.

How should I take over-the-counter medications for diarrhea?

It’s important to always follow the instructions on the packaging when you take an over-the-counter medication for diarrhea. The rules for managing diarrhea in an adult are different than in children. Always call your child’s healthcare provider before giving your child any type of medication for diarrhea.

A tip for managing diarrhea in an adult with over-the-counter medication includes:

  • Taking two tablespoons of Kaopectate® or two tablespoons of Pepto-Bismol® after each loose stool. Do not take more than eight doses in 24 hours.

Can I manage diarrhea without taking any medication?

When you have an acute case of diarrhea, you can often take care of it without needing any medication. Several things you can do to care for diarrhea include:

  • Drinking plenty of water and other electrolyte balanced fluids (like diluted and pulp-free fruit juices, broths, sports drinks (Gatorade®) and caffeine-free sodas). Make sure to hydrate throughout day. Your body loses water each time you have diarrhea. By drinking plenty of extra fluids, you are protecting your body from dehydration.
  • Changing your diet. Instead of picking greasy, fatty or fried foods, go for the BRAT diet:
    • B: Bananas.
    • R: Rice (white rice).
    • A: Applesauce.
    • T: Toast (white bread).
  • Cutting back on caffeine. Foods and drinks that have caffeine can have a mild laxative effect, which can make your diarrhea worse. Foods and drinks with caffeine include coffee, diet sodas, strong tea/green tea, and even chocolate.
  • Avoiding foods and drinks that give you gas. If you experience cramping in your stomach with diarrhea, it could help to cut back on things that cause gas. These can include beans, cabbage, Brussels sprouts, beer and carbonated beverages.

Sometimes, diarrhea can also make you lactose intolerant. This is usually temporary and it means that you need to avoid items with lactose (dairy products) until your diarrhea is gone.

Are there any foods that can help my diarrhea go away?

You actually can help your diarrhea by changing your diet. Certain low-fiber foods can help make your stool more solid.

If you have diarrhea, try adding these foods into your diet:

  • Potatoes.
  • Rice (white).
  • Noodles.
  • Bananas.
  • Applesauce.
  • White bread.
  • Chicken or turkey without the skin.
  • Lean ground beef.
  • Fish.

What do I do if my baby or young child has diarrhea?

If your child has severe diarrhea, call your healthcare provider. Young children are at a higher risk of dehydration than adults. You also can’t treat a child’s diarrhea the same way you would an adult case. Over-the-counter medications can be dangerous in young children and all treatments of diarrhea in children should be guided by their healthcare provider. It’s important to keep your child hydrated. Your provider will help you determine the best way to do this, but options often include:

  • Breast milk.
  • Formula.
  • Electrolyte drinks (Pedialyte®) for older children – this is not recommended for babies.

The best option to keep your child hydrated might change as the child ages. Always check with your provider before giving your child a new liquid or treatment of any kind.

If you have any questions or concerns about your child’s diarrhea, don’t hesitate to call your provider.

How can I relieve discomfort in the rectal area caused by diarrhea?

Diarrhea often means frequent trips to the bathroom. This can cause discomforts like:

  • Itching.
  • Burning.
  • Pain during bowel movements.

If you’re experiencing any of these discomforts, there are a few things you can do to help, including:

  • Sitting in a few inches of lukewarm water in a bathtub.
  • Patting your rectal area dry with a clean soft towel after getting out of the tub or shower. Don’t rub the area dry because that will only make the irritation worse.
  • Applying petroleum jelly or a hemorrhoid cream to your anus.

Prevention

Can diarrhea be prevented?

There are a few ways you can decrease your chances of having diarrhea, including:

  • Avoiding infections with good hygiene habits: Washing your hands with soap and water after using the bathroom, as well as cooking, handling, and eating, is an important way to prevent diarrhea. Washing your hands thoroughly can really help keep you and those around you stay healthy.
  • Getting your vaccinations: Rotavirus, one of the causes of diarrhea, can be prevented with the rotavirus vaccine. This is given to infants in several stages during the first year of life.
  • Storing food properly: By keeping your food stored at the right temperatures, not eating things that have gone bad, cooking food to the recommended temperature and handling all foods safely, you can prevent diarrhea.
  • Watching what you drink when you travel: Traveler’s diarrhea can happen when you drink water or other drinks that haven’t been treated correctly. This is most likely to happen in developing countries. To avoid getting diarrhea there are a few tips to follow. Watch what you drink. Don’t drink tap water, use ice cubes, brush your teeth with tap water, or consume unpasteurized milk, milk products or unpasteurized juices. You should also be careful when trying local foods from street vendors, eating raw or undercooked meats (and shellfish), as well as raw fruits and vegetables. When in doubt, drink bottled water or something that’s been boiled first (coffee or tea).

Outlook / Prognosis

Is diarrhea fatal?

Diarrhea is extremely common, but that doesn’t mean it can’t be dangerous. In extreme cases of diarrhea, you can become very dehydrated and this can lead to serious complications. Dehydration is one of the most dangerous side effects of diarrhea. In the very young (infants and small children) and the very old, this can have serious consequences. It’s important to drink plenty of fluids with electrolytes when you have diarrhea. This allows your body to replace the fluid and electrolytes that are lost with the diarrhea.

In some parts of the world, diarrhea is a life-threatening condition because of dehydration and electrolyte loss.

Living With

When should I call my doctor about diarrhea?

If you have diarrhea that fails to improve or resolve completely, you should call your healthcare provider. Keep track of any other symptoms you may be experiencing – this includes fever, vomiting, rash, weakness, numbness, lightheadedness, dizziness, weight loss and blood in your stool. If you have any concerns, it’s always best to call your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 04/13/2020.

References

  • US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. Diarrhea. (https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea) Accessed 4/17/2020.
  • The Centers for Disease Control and Prevention. Diarrhea: Common Illness, Global Killer. (https://www.cdc.gov/healthywater/pdf/global/programs/globaldiarrhea508c.pdf) Accessed 4/17/2020.
  • Merck Manual Professional Version. Diarrhea. (https://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/diarrhea) Accessed 4/17/2020.

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